Parental views on their children's smartphone use during personal and relational activities.

Given the negative outcomes associated with smartphone use during personal and relational activities (SUPRA), parents strive to regulate its use among their children. However, media parenting recommendations lack knowledge of parental views on SUPRA and their relative occurrence in youths. This study aimed to (i) estimate SUPRA frequency among children and adolescents, (ii) assess parental dislike (PD) of SUPRA, and (iii) identify predictors of PD of SUPRA. An online survey was completed by 826 parents (49% mothers, age 25-74, Median = 43 years), capturing PD of SUPRA, estimated frequency of SUPRA in their children (49% female, age 6-18, Median = 10 years), parenting styles (warmth and control), parental attitudes toward screen media, and sociodemographic characteristics. The rate of frequent SUPRA was significantly higher in adolescents (2.7-48.1%) compared to children (2.1-27.2%) with odds ratios ranging from 0.67 to 3.04, depending on the activity type. PD of SUPRA was high in parents of children (M = 4.04, SD = 0.66) and adolescents (M = 3.93, SD = 0.71). Linear regression identified being a mother, having higher levels of control and warmth, and less positive attitudes toward screen media as significant predictors of SUPRA dislike. Our study was the first to report the estimated occurrence and parental dislike of smartphone use (SU) during various personal and relational activities, enabling their direct comparison. Experts warn against SU while studying and at bedtime, which frequently occurred in 4-5% of children and 10-12% of adolescents. More attention should be paid to SU during relational (peer/family) activities due to its relatively high occurrence and parental dissatisfaction.

Parenting through place-of-care disruptions: A qualitative study of parents' experiences of neonatal care.

INTRODUCTION: Neonatal care is complex, involving multiple people and technologies within a community of care. When preterm babies are cared for far from home and/or transferred between units, the whole community of care (and particularly parent participation) is disrupted. Although previous studies have captured subjective experiences of parents, there has been little research exploring the material practices undertaken by parents as a consequence of place-of-care decisions, or the social organisation of those practices. METHODS: As part of a wider study exploring optimal place-of-care, semistructured interviews were conducted between July 2018 and October 2019 with 48 parents (36 families) with one or more preterm babies (born at 27-31 weeks gestation) cared for in a neonatal unit in the last 12 months. FINDINGS: We highlight parents' labour-intensive and stressful work to: (1) parent in the neonatal care community (an oversight role that goes beyond contemporary notions of 'involvement'); (2) create continuity amid place-of-care disruptions; and (3) adapt to the managerial logics of neonatal care settings. Our analysis focuses on the work generated by managerial systems that organise place-of-care decision-making and other efficiency-focused practices. Parents are absorbed into negotiating institutional systems and diverted from routine parenting activities. CONCLUSION: Those involved in the organisation and management of neonatal care should take account of how managerial systems impact parents' workload, ability to participate in their baby's community of care and, ultimately, on the wellbeing and development of babies and their families. PATIENT OR PUBLIC CONTRIBUTION: The OPTI-PREM study embedded parents' experiences of neonatal care into the research, through a discrete workstream that employed qualitative methodology to capture parents' experiences-as reported in this paper. The OPTI-PREM project was also supported by a Bliss volunteer parent panel, which was involved in designing and overseeing the research. Bliss 'champion[s] the right for every baby born premature or sick to receive the best care by supporting families, campaigning for change and supporting professionals and enabling life-changing research' (https://www.bliss.org.uk/about-us/about-bliss). A representative of Bliss is a co-author of this manuscript, and a parent representative (named in the Acknowledgements) provided feedback during its preparation.

Psychological well-being and needs of parents and carers of children and young people with mental health difficulties: a quantitative systematic review with meta-analyses.

QUESTION: For parents of children and young people (CYP) with diagnosed mental health difficulties, what are the levels of parents' well-being and psychological need? STUDY SELECTION AND ANALYSIS: Medline, PsycINFO, EMBASE, AMED, CINAHL, Web of Science and Cochrane Library of Registered Trials were searched from inception to June 2023. INCLUSION CRITERIA: parents of CYP aged 5-18 years with formal mental health diagnosis. Data were extracted from validated measures of well-being or psychological needs with established cut-off points or from a controlled study. FINDINGS: 32 of the 73 310 records screened were included. Pooled means showed clinical range scores for one measure of depression, and all included measures of anxiety, parenting stress and general stress. Meta-analyses showed greater depression (g=0.24, 95% CI 0.11 to 0.38) and parenting stress (g=0.34, 95% CI 0.20 to 0.49) in parents of CYP with mental health difficulties versus those without. Mothers reported greater depression (g=0.42, 95% CI 0.18 to 0.66) and anxiety (g=0.73, 95% CI 0.27 to 1.18) than fathers. Narrative synthesis found no clear patterns in relation to CYP condition. Rates of parents with clinically relevant levels of distress varied. Typically, anxiety, parenting stress and general stress scored above clinical threshold. Quality appraisal revealed few studies with a clearly defined control group, or attempts to control for important variables such as parent gender. CONCLUSIONS: The somewhat mixed results suggest clinical anxiety, parenting and general stress may be common, with sometimes high depression. Assessment and support for parents of CYP with mental health problems is required. Further controlled studies, with consideration of pre-existing parental mental health difficulties are required. PROSPERO REGISTRATION NUMBER: CRD42022344453.

Children's screen time and psychosocial symptoms at 5 years of age - the role of parental factors.

BACKGROUND AND OBJECTIVES: Electronic media (e-media) has become a universal part of young children's daily lives. Previous studies have found an association between increased screen time and children's psychosocial symptoms. We investigated whether parents' psychological distress and parenting style dimensions explain the association between children's screen time and psychosocial symptoms. Moreover, we investigated whether parents' mental well-being and parenting style dimensions moderate this association. METHODS: We used data from the Finnish CHILD-SLEEP birth cohort study. Parents and the child were assessed when the child was 5 years old (N = 671). The measure of screen time included program viewing from TV and other devices. Child's psychosocial problems and parents' depression, stress and parenting style dimensions were assessed by self-reports. RESULTS: A high level of screen time in children was associated with attention and concentration difficulties, hyperactivity and impulsivity symptoms as well as internalizing and externalizing symptoms among 5-year-olds. For the most part, the associations remained significant despite controlling for parents' mental health, parenting style dimensions and multiple background factors, especially associations relating to attention and concentration difficulties and hyperactivity symptoms were robust. Maternal stress and depression moderated the association between children's screen time and psychosocial symptoms, indicating a more pronounced association among stressed or depressed mothers. CONCLUSION: There is an independent association between children's screen time and psychosocial symptoms which is especially pronounced among those children whose mothers had poorer mental well-being. In clinical practice, the length of screen time should be inquired already at a young age and parents should be offered guidance to reduce the possible ill effects of excessive screen time, as well as help with their own mental health problems.

Parenting During the COVID-19 Pandemic.

Parenting during the COVID-19 pandemic was an unprecedented experience for many families around the world. With the sudden closure of schools and child care centers and the implementation of stay-at-home orders, parents were required to adjust to a new normal, one that required them to take on numerous responsibilities, all with diminished levels of social support. These changes resulted in a wide range of experiences, from feelings of overwhelm and stress to gratitude for time that was often not a reality in the hustle-bustle of everyday life in pre-pandemic times. This chapter discusses parenting during the COVID-19 pandemic, reviewing the impact on parental mental health, the impact on the parent-child relationship, and the implications for families and societal support.

Application of the Social Cognitive Theory amid food parenting practices of Black immigrant mothers in the US: A qualitative study.

BACKGROUND: Children of Black immigrant parents living in the US are at elevated risk of being overweight or obese, thus increasing their risks of morbidity and mortality as they age. Parents play a crucial role in shaping their children's nutrition through their food parenting practices. The Social Cognitive Theory (SCT) can explain Black immigrant mother's FPP and their children's dietary behavior. This study aimed to assess SCT's constructs, personal (maternal knowledge, attitudes, beliefs) and environmental factors (acculturation) in relation to the behavioral factor (food parenting practices) among a sample of Black immigrant mothers living in Metro Atlanta, Georgia. METHODS: Convenience sampling was employed to recruit 30 Black immigrant mothers who lived in seven Metro Atlanta, Georgia counties in the summer of 2022. Four focus group interviews were conducted over two weeks. The qualitative data analysis was thematic. RESULTS: Focus group data analysis revealed seven major themes: knowledge, attitude, belief, modeling, acculturation, coercive control, and structure, and six subthemes. Mothers discussed being intentional about encouraging healthy foods and limiting unhealthy foods for their children. Overall, acculturation influenced mothers' food parenting practices. Since migrating to the US, some mothers' nutrition changed in positive (e.g., eating more fruits) and negative ways (e.g., snacking more) because of schedules, cost, and access. Children ate a mixed diet, the mother's native diet and the American diet, and the former was considered healthier and affordable by most. CONCLUSION: This is the first study to look at the food parenting practices of Black immigrants in the US. By identifying key factors that influence the food parenting practices of this population and their children's dietary habits, this study's findings are useful to practitioners or researchers who work with this population on nutrition.

'We are all children of war': a qualitative inquiry into parenting following adolescents' recent traumatic exposure in a multiple crisis setting in Beirut, Lebanon.

Background: Strong familial bonds are crucial to building resilience among youth exposed to traumatic events in socially adverse environments. Exploring parental experiences in the aftermath of adolescents' traumatic exposure in these settings would help tailor early interventions.Objective: We qualitatively explored experiences and perceived needs among parents of teenagers aged 11-16 years who were exposed in the last three months to a potentially traumatic event in Beirut, Lebanon.Method: We purposively sampled 28 parents of 24 adolescents meeting the inclusion criteria. Semi-structured interviews were conducted, and thematic analysis was applied combined with a grounded theory approach.Results: The most frequent traumatic event was direct exposure to the violent clashes that happened in Beirut on 14 October 2021. Parents identified that the recent event exacerbated pre-existing mental health difficulties caused by cumulative stress. They were reminded of their own war experiences and tended to reject the 'sick role' associated with trauma. A majority of participants viewed resilience as a fixed trait characteristic of the Lebanese and avoided communication with their children about traumatic memories, while a significant minority criticised resilience as a myth that added pressure on them and had more open communication about trauma. Parenting styles oscillated between controlling behaviours, warmth, and avoidance, which impacted the family dynamic. Despite adversity, most parents tried to cope through social connectedness, humour, and living day by day.Conclusions: Our findings hold implications for contextual adaptations of early posttraumatic interventions aimed at strengthening family support, such as addressing parental mental health; increasing awareness among first-line responders on parents' potential representations of trauma and resilience; addressing the issue of controlling parenting; and including a component in psychoeducation on traumatic stress that validates the impact of daily stressors on mental health while avoiding direct labelling. Further research is needed to validate the impact of these domains.

Parents of adolescents recently exposed to trauma in Beirut endure cumulative stress and recall war memories.Some parents see resilience as innate, and others criticise it as a myth.Early interventions should target parental mental health and conceptions on trauma and resilience.

Mothers with low incomes view both individual and structural interventions as potentially helpful for supporting early child development.

Many developmental psychologists aspire to conduct research that informs interventions and policies to prevent income-related disparities in child development. Among growing researcher discussion about the value of interventions that target "structural" and resource-related correlates of income inequality and child development (e.g., housing, food, material goods, cash), rather than individual, person-centered correlates (e.g., parenting behaviors), the perspectives of mothers with low incomes may provide important context. 281 mothers with young children and low incomes rated various structural and individual interventions, framed as having minimal costs and entry barriers, for their perceived helpfulness. Analyses were pre-registered. Overall, mothers rated all interventions very highly, though they rated structural interventions as slightly more helpful than individual interventions. Mothers rated interventions they used in the past as less helpful than those they hadn't previously used. An exploratory qualitative analysis revealed mothers' desires for supports in other intervention domains beyond those addressed in our survey. Together, mothers' responses indicated that they did not see individual interventions as inherently unhelpful due to a focus on individual states, knowledge, and skills. Implications for developmental psychology and intervention science are discussed.

Replicability, adaptability and long-term impact of the 'Healthy Youngsters, Healthy Dads' program in Newcastle, Australia.

'Healthy Youngsters, Healthy Dads' (HYHD) targets fathers to improve the health of their preschool-aged children. In a previous randomized trial, fathers and children experienced meaningful improvements in physical activity and eating behaviours. The next phase is to test the replicability and adaptability of HYHD when delivered in the community by trained facilitators. Fathers/father-figures and children aged 3-5 years were recruited from Newcastle, Australia into a 9-week, non-randomized trial with assessments at baseline, 10 weeks, and 12 months. The primary outcome was achievement of pre-registered targets for recruitment (≥ 96 dyads), attendance (≥ 70%), compliance (completing ≥ 70% of home-based tasks), fidelity (≥ 80% of content delivered as intended) and program satisfaction (≥ 4/5). Secondary outcomes included physical activity, nutrition, screen time and parenting measures. Process targets were surpassed for recruitment (140 fathers, 141 children), attendance (79% for fathers-only workshops, 81% for father-child sessions), compliance (80% of home-tasks completed), fidelity (99% for education, ≥ 97% for practical) and program satisfaction (4.8/5). Mixed effects regression models revealed significant effects in fathers for moderate-to-vigorous physical activity, co-physical activity, dietary intake and parenting practises, which were maintained at 12 months. Significant effects were also established for screen time at 10 weeks only. For children, significant effects were observed for screen time and dietary intake at 10 weeks, while effects on energy-dense, nutrient-poor foods and healthy, nutrient-dense core food intake were maintained at 12 months. Findings demonstrate the replicability and adaptability of HYHD when delivered in the community by local trained facilitators. Further investigation into how to optimally scale-up HYHD is warranted.

Practicable strategies parents can apply in their daily routine to successfully implement the 50/50-split-model of paid work, childcare, and housework: a qualitative content analysis.

BACKGROUND: Many young couples are planning to share paid work, childcare, and housework equally between each other. But implementing such a 50/50-split-model is difficult and parents often return to traditional gender role distributions after the birth of a child. This return has potential negative effects on mental health, physical health, and relationship satisfaction. Therefore, this study aims to find practicable strategies on a behavioral-level which new parents can apply in their daily routine to successfully implement the 50/50-split-model if they wish to do so. METHODS: This qualitative study, DREAMTALK, is part of the multi-method, prospective Dresden Study on Parenting, Work, and Mental Health (DREAM). For DREAMTALK, N = 25 parents implementing a 50/50-split-model were selected based on quantitative data regarding time use, which participants had provided in questionnaires. In DREAMTALK, problem-centered interviews were conducted with the selected sample at 17 months postpartum. Those were analyzed via qualitative content analysis, which is systematic, rule-guided, and based on the criteria of validity and reliability. RESULTS: The qualitative content analysis revealed a catalog of 38 practicable strategies to manage daily routine, which can help parents to successfully implement a 50/50-split-model. Individual participants used 23 success strategies on average. Examples include having a regular coordination appointment with the other parent, planning foresightedly, flexibility, reducing cleaning, optimization of routes, or moderate split-shift parenting. Some of these strategies seem opposing, e.g., planning foresightedly, and at the same time, meeting unpredicted changes with flexibility. Those seemingly opposing strategies were well balanced by the participants, which was an additional strategy. CONCLUSIONS: Parents can use the success strategies relatively independently of external circumstances. This behavioral perspective extends prior theories, which have focused on explaining unequal gender role distributions with external circumstances. A behavioral perspective can be a gateway to assist more parents to pioneer in implementing the 50/50-split-model, which might in turn lead to a healthier and more satisfied public population.

Cross-cultural adaptation and psychometric properties of the Malay version of parenting and child tooth brushing assessment (M-PACTA).

BACKGROUND: Malaysian preschool children continue to exhibit a high prevalence of dental caries and poor oral hygiene. There is a need to gain an in-depth understanding of oral hygiene habits and design suitable interventions to improve oral hygiene in early childhood. OBJECTIVE: To cross-culturally adapt and determine the psychometric properties of the Malay-translated Parenting and Child Tooth Brushing Assessment questionnaire (M-PACTA). METHODOLOGY: This cross-sectional study involved face and content validation, and forward and back-translation of PACTA. The M-PACTA was then tested for reliability and construct validity on 150 Malaysian parents of children aged 5 to 6 years old. RESULTS: Face validity indicated that the M-PACTA items were clear and easy to understand. For content validity, some words had to be modified in accordance with the recommendations of the expert committees to make it more coherent to Malaysians. Some statements in the parental knowledge scales were modified according to the guidelines applicable in Malaysia. The content comparison of the back translation with the adapted PACTA revealed that all items were semantic and linguistically equivalent. Exploratory factor analyses of M-PACTA suggested a two-factor structure for three scales including child behaviour scale ('non-compliance' and 'avoidance behaviour'), parental attitudes ('lack of concern' and 'attitude of care'), and parental knowledge ('general tooth brushing knowledge' and 'awareness of tooth brushing care') while for the parental strategy scale, three-factor structure was extracted including 'routine positive methods', 'uncommon positive methods', and 'negative methods'. Internal consistencies for all scales were good (α > 0.9). CONCLUSION: M-PACTA did not replicate the construct of the original PACTA. Nonetheless, M-PACTA demonstrated good construct validity, internal consistency reliability, and test-retest reliability within Malaysian context.

Effects of multi-component parenting and parental mental health interventions on early childhood development and parent outcomes: a systematic review and meta-analysis.

BACKGROUND: Interventions supporting parents of young children often target parenting or parental mental health separately. Multi-component parenting and parental mental health interventions have the potential to improve parenting practices, mental health, and early childhood development. We aimed to examine their impact on child and parent outcomes. METHODS: In this systematic review and meta-analysis, we searched MEDLINE, Embase, Web of Science Core Collection, APA PsycINFO, CINAHL Complete, the Cochrane Central Register of Controlled Trials, and the Global Health Database from inception to Jan 23, 2024. Eligible studies were randomised controlled trials of interventions explicitly targeting parenting behaviours and parental mental health antenatally or in children's first 3 years of life. Screening, extraction, and quality assessment were done independently by two authors. Primary outcomes were cognitive and social-emotional functioning in children and depressive symptoms in parents, meta-analysed as standardised mean differences (SMDs), relative to control. This study is registered with PROSPERO, CRD42022302848. FINDINGS: We found 5843 records. After screening 2636 (45·1%) titles and abstracts, we manually identified and screened three additional articles and excluded 2177 records. After screening 462 full-length articles, 25 articles, representing a sample size of 8520 children and caregivers, were included. At baseline, mean caregiver age was 27·7 years (SD 5·9) and mean child age (excluding those enrolled during pregnancy) was 14·4 months (8·0). Interventions lasted a mean of 14 months (SD 11) and used a mean of 3·7 behaviour change techniques (2·0). Most interventions dedicated more time to parenting behaviours than to parental mental health. We found significant intervention effects on children's cognitive (SMD 0·19 [95% CI 0·04 to 0·34]; I2=69%) and social-emotional (0·26 [0·17 to 0·34]; I2=47%) outcomes but not on depressive symptoms in female caregivers (-0·18 [-0·36 to 0·002]; I2=86%) relative to control conditions. Risk of bias across studies was moderate, and we found heterogeneity across results. INTERPRETATION: Multi-component parenting and mental health interventions had a positive effect on child cognitive and social-emotional outcomes, but not on depressive symptoms in parents, suggesting that other factors might contribute to positive ECD outcomes. Interventions might lack adequate focus on mental health to make a discernible impact, highlighting a need for future studies to differentiate and assess contributions of parenting and mental health components to understand independent and collective effects on family outcomes. FUNDING: Canadian Institutes of Health Research.

[Teenage pregnancy and parenthood, a review of the literature]. / Grossesses et parentalités adolescentes, une revue de la littérature.

Teenage parenthood involves a dual transition to adulthood and parenthood. A small-scale phenomenon, there remains a gap between statistical reality and social perception. The media and politicians take up the issue as a synonym for socio-psychological difficulties. The literature points in particular to the consequences of these maternities on the future of mothers, children and their relationships. However, some studies qualify the literature by identifying different types of teenage pregnancy and parenthood profiles.

[Adolescent parenthood: how can caregivers provide support in a parent-baby day hospital?] / Parentalités adolescentes : quels accompagnements possibles par le soignant au sein d'un hôpital de jour parents-bébé ?

Adolescent parenthood is a risky situation for the mental health of young people and for the development of infants. Yet adherence to psychological care remains difficult at this stage of life, notably because of the insecurity of attachment bonds often present in these young people. The "Les Oursons" parent-baby day hospital is presented, and clinical cases involving adolescent parents are discussed. They illustrate the particular interest of a global approach to father, mother and baby, and underline the opportunities to anchor initial psychological care for each. Network and community care are also interesting avenues to explore.

Evaluation of adapted parent training for challenging behaviour in pre-school children with moderate to severe intellectual developmental disabilities: A randomised controlled trial.

OBJECTIVES: There is limited evidence on the effectiveness of parenting interventions to improve disruptive behaviour in children with intellectual developmental disabilities. This clinical trial evaluated whether an adapted group parenting intervention for preschool children with intellectual developmental disabilities who display challenging behaviour is superior to treatment as usual in England. STUDY DESIGN: 261 children aged 30-59 months with moderate to severe intellectual developmental disabilities and challenging behaviour were randomised to either the intervention (Stepping Stones Triple P) and treatment as usual or treatment as usual alone. The primary outcome was the parent-rated Child Behaviour Checklist at 52 weeks after randomisation. A health economic evaluation was also completed. RESULTS: We found no significant difference between arms on the primary outcome (mean difference -4.23; 95% CI: -9.99 to 1.53; p = 0.147). However, a subgroup analysis suggests the intervention was effective for participants randomised before the COVID-19 pandemic (mean difference -7.12; 95% CI: -13.44 to -0.81; p = 0.046). Furthermore, a complier average causal effects analysis (mean difference -11.53; 95% CI: -26.97 to 3.91; p = 0.143) suggests the intervention requires participants to receive a sufficient intervention dose. The intervention generated statistically significant cost savings (-£1,057.88; 95% CI -£3,218.6 to -£46.67) but the mean point estimate in Quality Adjusted Life Years was similar in both groups. CONCLUSION: This study did not find an effect of the intervention on reducing challenging behaviour, but this may have been influenced by problems with engagement. The intervention could be considered by services as an early intervention if families are supported to attend, especially given its low cost.

Religious Coping as Mediator of Sense of Competence and Post-traumatic Growth in Mothers of Children With Cerebral Palsy.

OBJECTIVES: The present study aimed to determine whether religious coping mediates the relationship between parenting sense of competence (PSOC) and post-traumatic growth (PTG). METHOD: Cross-sectional research design was used. A sample of 74 mothers (age range; 20-45 years) of CP children (age range; 2-9 years) was collected through purposive sampling from different physiotherapy centres and special education schools of Lahore. PSOC scale, brief RCOPE and PTG inventory were used. RESULTS: Positive religious coping partially mediated (ß = 0.190, 95% CI [0.026, 0.374], p < 0.05) between PSOC and PTG. Partial mediation exists between PSOC and appreciation of life through pathway of positive religious coping (ß = 0.040, 95% CI [0.007, 0.075], p < 05). Full mediation exists between PSOC and personal strength through pathway of positive religious coping (ß = 0.041, 95% CI [0.001, 0.081], p < 0.05) and through negative religious coping (ß = 0.034, 95% CI [0.002, 0.066], p < 0.05). Positive religious coping fully mediated (ß = 0.029, 95% CI [0.007, 0.058], p < 0.05) between PSOC and spiritual change. Moreover, indirect effect of PSOC on relating to others and new possibilities through positive and negative religious coping was non-significant, indicating no mediation. CONCLUSION: Positive religious coping affected the association between PSOC and PTG, that is, mothers of CP children having high parenting competence are more likely to use positive religious coping strategies that results in more PTG.

Effect of the COPE Program on Self-Efficacy in Mothers of Preterm Infants: A Pretest-Posttest Quasi-Experimental Study.

The birth of a premature infant and its subsequent hospitalization in the neonatal intensive care unit are stressful experiences for mothers. Because of uncertainty concerning interactions with a premature baby, mothers often feel helpless and only hesitantly assume their maternal role. This may have a negative impact on the mother-child interaction and prevents mothers from taking an active part in E46www.jpnnjournal.com the care for their child. "Creating Opportunities for Parent Empowerment" (COPE) is a 4-phase educational intervention program aiming to systematically involve parents into caring for their premature infant. In this pretest-posttest quasi-experimental study in 2 Swiss university hospitals, we focused on maternal self-efficacy. We compared self-efficacy in mothers receiving the COPE program or standard care alone at baseline and 3 months after estimated delivery date. To measure maternal self-efficacy, we used the "Tool to measure Parenting Self-Efficacy" (TOPSE). While scores for "Emotion and Affection," "Empathy and Understanding," as well as "Learning and Knowledge" increased in both groups, only "Learning and Knowledge" scores were significantly higher in the intervention group. Given the intention of improving learning and knowledge, the COPE program might be a promising intervention contributing to enhanced maternal self-efficacy.